Tuesday, April 19, 2011

CMS Clarifies Requirements for Home Health Services

The Centers for Medicare and Medicaid Services (CMS) recently issued a transmittal that makes changes to the home health provisions contained in the Medicare Benefits Policy Manual (Pub 100-02, Chapter 7) based on the Calendar Year 2011 Final Rule for Home Health.

Of importance to physical therapists are the sections on the general principles governing reasonable and necessary services and the application of the principles to physical therapy services. Under general principles (section 40.2.1), CMS discusses the process for determining whether individual therapy services are skilled and whether, in view of the patient's overall condition, skilled management of the services provided is needed. This section outlines how the assessment, measurement, and documentation of therapy effectiveness must support the necessity of services. In particular, the transmittal provides guidance on restorative therapy and also on designing or establishing a maintenance program.

Comments

Do the rules still state that home care must be provided by a home health agency using a licensed person? Can a licensed independent therapist take on a home care patient and bill Medicare for the service. I have a private outpatient office. Thanks.

Posted by Alan Silk, PT
on 4/22/2011 6:36 PM

Do the rules still state that home care must be provided by a home health agency using a licensed person? Can a licensed independent therapist take on a home care patient and bill Medicare for the service?
Thanks, Judy Talmo

Posted by Judith M. Talmo PT
on 4/23/2011 9:04 AM

You would have to bill under part B or see the patient through a home health agency as a contractor to bill part A.